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Clinical Crossroads | Clinician's Corner

A 58-Year-Old Man With a Diagnosis of Chronic Lyme Disease

Allen C. Steere, MD, Discussant
JAMA. 2002;288(8):1002-1010. doi:10.1001/jama.288.8.1002.
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DR BURNS: Mr C is a 58-year-old man diagnosed as having chronic Lyme disease. He lives in a suburb of Boston and works as a consultant. He has managed care insurance.

Mr C had an episode of Bell's palsy on the left side of his face in August 1992 and reported that he spent a lot of time on Martha's Vineyard, an endemic area for Lyme disease. Subsequently, he noticed that he became less competent mentally. He could not do simple math and he became depressed. In 1994, he was diagnosed as having Lyme disease. At that time, he complained of neck pain radiating to his left shoulder and hand, with numbness and tingling in his hand; back pain that radiated down his left leg; bilateral joint aches in both elbows and, to a lesser extent, his shoulders; bilateral tinnitus; periodic blurred vision (worse in the right eye than the left); difficulty concentrating and word finding; and periodic sweats. Results of his physical examination were normal with the exception of having difficulty spelling "world" backward and subtracting 7 serially. In October 1994, his Lyme (IgM/IgG) antibody titer was positive at 1:4. He was treated with tetracycline, 500 mg 3 times daily for 1 year.

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